(5) Traumatic Brain Injury Flashcards
What are the most common acquired brain injuries?
- Stokes
- Road accidents
- Falls
- Tumour
- Assault
What is traumatic brain injury?
An insult to the brain by an external physical force that may produce a diminishes or altered state of consciousness, which results in impairment of physical abilities and/or cognitive function.
What is a contrecoup injury?
Are head injuries that most often involve cerebral contusions and traumatic subarachnoid hemorrhage
What is cerebral concussion?
- Shaking of the brain
- Brief loss consciousness
- Headache
- Dizziness
- Amnesia
What is cerebral contusion?
- Bruise
- Small haemorrhage
What is cerebral laceration?
Tear of cortical surface with contusion
What are the two types of impact damage to the brain?
- Cortical contusions and lacerations associate with haemorrhage
- Diffuse axonal injury involves shearing of axons causing disruption of nerve impulses
What are the different types of secondary brain damage?
- Intracranial haematoma
- Cerebral swelling
- Tentorial or tonsillar herniation
- Cerebral ischaemia
- Infection
What types of haemorrhage occur post TBI?
- Epidural
- Subdural
- Intracerebral
What is brain death?
Is when the entire brain, including the brain stem has irreversibly lost function
What are normal vs negative pupil responses?
- Normal the pupil constricts to light
- Negative there is no change in pupil size
What are tests to determine brain death?
- Pupil response
- Corneal reflex
- Absence of VOR
- Pain test
- Anoxia test
What is the brain death procedure?
- Carried out by two doctors both with expertise
- Tests should be repeated 12-24 hours later
What is cerebral perfusion?
Blood circulating around the brain at sufficient speed and force to maintain sufficient O2
What is cerebral perfusion influenced by?
- Blood pressure
- Intracranial pressure
What can cause cerebral ischaemia?
- Hypoxia
- Decrease in cerebral perfusion
What is meningitis?
Infection of the meninges
What is cerebral abscess?
Serious infection of the brain where pus pockets full of infected material form
What can lead to infection in the brain?
- Dural tear (CSF leak)
- Compound depressed fracture
- Base of skull fracture
What are the main objective during the acute phase of TBI?
- Ensure sufficient blood O2 levels
- Maintain cerebral perfusion pressure
- Control raised intracranial pressure
- Keep blood pressure stable
- Prevent secondary brain damage
What are the priorities of assessment for multiple injuries?
- Check airways
- Breathing (O2 and resp mvmts)
- Circulation (pulse and BP)
- Chest/abdominal injury
- Head/spinal injury (Conscious level)
- Limb injury
What is looked for during assessment?
- period of loss consciousness
- period of post traumatic amnesia
- cause and circumstances of injury
- headache and vomiting
- evidence of injury
- pupil response and other cranial nerves
- Glasgow coma scale
What is involved in the Glasgow Coma Scale?
- Eye opening
- Verbal response
- Best motor response
How is the severity of the injury decided?
- Lowest GCS in first 24 hours
- Depth of coma/altered consciousness
- Duration of coma
What is post traumatic amnesia?
Period from injury until return of day-to-day memory on a continuous basis
How is the severity of post traumatic amnesia decided?
- Mild < 1hour
- Moderate between 1-24 hours
- Severe 24 hours to 7 days
- Very severe > 7 days
What is the management of TBI in the acute phase?
- Look at ICP and GCS
- Maintain good cerebral perfusion
- Prevent secondary brain damage
- Resp physio as necessary
- Maintain muscle length
- Good positioning
What does the respiratory treatment in the acute phase involve?
- Maintain good cerebral perfusion
- Assess resp status
- O2 sats, ICP, BP, CXR, Ausc
- Positioning and muscle length
- Minimize effects spasticity
What is other treatment during the acute phase when the patient is stable?
- Functional bed mobility
- Watch tendon achilles closely for signs shortening
- Early standing, sitting
- Care of airway & other tubes
What can brain stem swelling/damage lead to?
Rigidity
What are the different stages of recovery?
- Agitation
- Aggression
- Becoming aware of injuries
- Possible depression
What effects does TBI have on motor function?
- Spasticity
- Hyperreflexia
- Abnormalities of mvmt and posture
- Trunk/limb weakness
- Tremor
- Incoordination
- Dysphagia & Dysarthria
- Incontinence
- Epiliepsy
- Fatigue
- Heterotrophic ossification
What are some cognitive, behavioural and psychological problems associated with TBI?
- memory
- confusion
- poor judgement & reasoning
- personality changes
- disinhibition & impulsiveness
- emotional liability
- perceptual deficits
- depression
- language deficits
- economic and social impact
What is involved in management of a subacute TBI?
- Thorough assessment
- Head control, sitting and standing balance
- Problem list
- Short and long term goals
- MDT N.B
What are the aims of treatment in rehab phase?
- normalise tone
- facilitate normal movement
- sensory stimulation
- communicate with family
- restore function
- consider effects cognitive problems
- restore physical fitness
- behavioural modification
- continuous evaluation
What are some discharge considerations?
- Home support
- Community services
- Headway Ireland
- Vocational retraining
- Long-term neurological difficulties
